Despite billions of dollars spent each year in the U.S. on research and treatment for combat veterans struggling with Posttraumatic Stress Disorder (PTSD), one fact has become clear: the current evidence-based approaches don't appear to be the magic bullet we hoped they would be.
As noted in the January 2017 edition of JAMA Psychiatry, "Despite the large increase in availability of evidence-based treatments, considerable room exists for improvement in treatment efficacy, and satisfaction appears bleak based on low treatment retention…we have probably come about as far as we can with current dominant clinical approaches.”
While our traditional approaches to treatment of PTSD may have gone as far as they can go, efforts and potential for breakthrough improvements in Posttraumatic Growth are just beginning.
For the past four years, a team of combat veterans, wellness professionals and evaluators have been working tirelessly to develop a new, innovative, effective, and accessible approach to facilitating strength and growth in our combat veterans. This innovation is taking place at Boulder Crest Retreat in Bluemont, Virginia.
The program called Warrior PATHH—Progressive and Alternative Training for Healing Heroes—leverages ancient warrior practices to help veterans live the lives they deserve; full of passion, purpose, and service here at home. The 18-month program starts with 7 days of intensive training that is founded on the science of Posttraumatic Growth and pulls heavily from the work of Drs. Richard Tedeschi and Lawrence Calhoun. Their three decades of research provides a proven framework for transforming deep struggle into profound strength and growth.
As of May 2017, 200 combat veterans are enrolled in the PATHH program. Approximately 50 participants are part of an 18-month program evaluation that's focused on identifying program processes and outcomes. To date, the outcomes look good. Participants are not just surviving, but thriving.
Using a variety of self-report measures, the initial indicators are strong. Ninety days after completing the 7-day training program, the group reported a 70 percent reduction in depressive symptoms and a 50 percent reduction in anxiety. During the same ninety-day period, on average, participants experienced a 28 percent reduction in stress, 21 percent increase in self-compassion, and an impressive 43 percent increase in posttraumatic growth.
The foundational wellness practice taught in Warrior PATHH is transcendental meditation or TM, complemented by other practices such as archery, yoga, mindfulness, psychoeducation, journaling, gratitude practice, disclosure and service. However, fundamental to sustaining personal growth is support and accountability through a guided support network after the program.
Perhaps the most impressive indicator of the value of the Warrior PATHH program is the extremely low dropout rates. Of the 200 participants, only 1 percent have failed to complete the program. This is far below traditional programs where dropout rates are as high as 50-60 percent. Additionally, a key ingredient of success is that the “PATHH Guides” who walk shoulder-to-shoulder with participants through the program are mostly combat veterans. All are currently practicing these techniques and are exhibiting Posttraumatic Growth as a result of their own struggles. Through their personal disclosure they share their own stories of struggle, lessons of growth, and as importantly, listen with empathy to others.
The intensive nature of Warrior PATHH is what separates it from many other programs and therapeutic modalities. The initial 7-day program and 18-month follow-up allows 100 hours of training and support to occur, compared to an average of 12-18 hours spent over the course of traditional therapy.
The financial return on investment is also a unique aspect of the program. In 2012, the Congressional Budget Office (CBO) found that the average first-year cost for PTSD treatment from the VA was $8,300. The 18-month Warrior PATHH program, which is completely privately funded, also costs about $8,300. Considering the 40-50 percent higher program completion rate with Warrior PATHH, the long-term costs are less.
The work at Boulder Crest in developing Warrior PATHH represents a change in philosophy. It moves from a symptom-centric mentality that focuses on maintaining the status quo, to a mentality consistent with Friedrich Nietzsche's belief of “that which does not kill us makes us stronger”. The Warrior PATHH is a hero’s journey of growth. It embraces the ideas that the same skills forged in battle can be leveraged to thrive at home and from deep struggle one can see incredible growth.
*This article was coauthored by Josh Goldberg, Director of Strategy at Boulder Crest Retreat and Dr. Bret A. Moore.